<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Presentation_drug_matrix_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-presentation_drug_matrix_id" data-rule="required" data-source="presentation/grug/matrix/index" class="form-control selectpage form-control" name="row[presentation_drug_matrix_id]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Source_of_assessment')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-source_of_assessment" class="form-control form-control" name="row[source_of_assessment]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Method_of_assessment')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-method_of_assessment" class="form-control form-control" name="row[method_of_assessment]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Result_of_assessmentg')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-result_of_assessmentg" class="form-control form-control" name="row[result_of_assessmentg]" type="text">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
